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Investigations Myelomengingocele
Prenatal Requires multidisciplinary approach with specialists from
-Family history of spina bifida is an indication for further several disciplines.
evaluation of an unborn child. This by: Initially important are
Antenatal ultrasonography Neurosurgical
Maternal serum and amniotic fluid alpha-fetoprotein Urologic
levels measurements. Orthopedic
-An open spinal column or a meningocele sac are readily Pediatric
apparent on an obstetrical ultrasound examination. – social service evaluations.
-Elevated maternal serum alpha-fetoprotein levels can be -Thorough evaluation of the infant and counseling of the family
associated with myelomeningocele and should prompt a close should generally precede intervention.
ultrasonographic examination. -It is important to assess the type, level, and extent of the
Counselling the parents of a spina bifida child is of the utmost lesion; the infant's general health status and associated
importance, particularly when the diagnosis is made deficits; the family's strengths, desires, and resources; and the
antepartum. community resources, including ongoing care.
Open discussion of possible outcome with option for abortion Once evaluation is complete, a decision can be made on how
should be carried out. aggressive treatment should be.
If the defect is leaking CSF, antibiotics and urgent
Post natal neurosurgical evaluation and repair will reduce the risk of
Evaluation of spina bifida meningeal or ventricular infection.
1. Spinal x-ray However with already manifest neurological deficit with good
2. spinal MRI skin cover then early surgery does not improve the function but
Other abnormalities its only for cosmetic function. Parents should be counseled
1.Plain x-ray and CT scan of the head to evaluate for about this.
hydrocephalus ,Chiari malformations and other associated With compromised urinary and fecal continence then at point of
cerebral malformations eg encephaloceles repair of bony defect then urine ad feccal diversion procedures
Ultrasonography has role in evaluation of hydrocephalus in could be attempted. Fecal incontinence may necessitate the
cases with open fontanels. fashioning of permanent colostomy.
Urinary system
1.Abdominal ultrasound-also evaluate GIT anomalies Other congenital anomaly-interval management as
2.IVU appropriate.
3.BUN and creatinine
-urinalysis, urine culture may be done for evaluation of UTI Hydrocephalus may require a shunt procedure
Cardiac
Echocardiography Hydronephrosis-nephrostomy may be done to preserve the
Musculoskeletal existing parenchymal tissue. Kidney function must be followed
Image the area affected Hip x-ray, foot x-ray closely, and UTI should be treated promptly.
Nephrostomy is the Establishment of an opening between the
Complications collecting system of the kidney through its parenchyma to the
1. If not well covered with skin, the sac can easily rupture, exterior of the body; may be performed by surgical incision or
increasing the risk of meningitis. be placed percutaneously.
2. When the spinal cord or lumbosacral nerve roots are
involved, as is usual, varying degrees of paralysis occur below Obstructive uropathy at either the bladder outlet or ureteral
the involved level. level must be treated vigorously, especially when infection
Since this paralysis occurs in the fetus, congenital orthopedic occurs.
problems can present at birth (eg, clubfoot, arthrogryposis,
dislocated hip). The paralysis usually affects bladder and rectal Orthopedic care should begin early. If a clubfoot is
functions, and the resulting GU disorder can eventually lead to present,serial casting should start birth .The hip joints should
severely damaged kidneys. be checked closely for dislocation. Other continuing orthopedic
3. Kyphosis, sometimes associated with spina bifida, can concerns are scoliosis, pathologic fractures, development of
hinder surgical closure and prevent the patient from lying pressure sores, and muscle weakness and spasm, which may
supine. cause further deformities.
4. Hydrocephalus occurs commonly and may be related to
aqueductal stenosis or an Arnold-Chiari malformation.
MANAGEMENT
Treatment
Spina bifida oculta
Has no neurological implications and re-assuarnce and
councelling of the patients.